بسم االله الرحمن الرحیم

(1)

ﻢﯿﺣﺮﻟا ﻦﻤﺣﺮﻟا ﷲا ﻢﺴﺑ

ﯽﻣﻼﺳﻻاﮥﻘﺛ تادﺎﺳاﺮﻫز ﺮﺘﮐد

يﺮﯿﺴﻣﺮﮔ و ﯽﻧﻮﻔﻋ يﺎﻬﯾرﺎﻤﯿﺑ ﺺﺼﺨﺘﻣ

ﻦﺑا يرورﺎﺑﺎﻧ نﺎﻣرد ﺰﮐﺮﻣ ﯽﺼﺼﺨﺗ ﻢﯿﺗﻮﻀﻋ

ﺎﻨﯿﺳ

(2)

Coronavirus disease 2019

COVID_19

SARS_Cov_2

(3)

Transmission

Person to person:

route of transmission: Direct person-to-person

respiratory transmission is the primary means of

transmission.

Viral shedding and period of infectiousness:The

potential to transmit SARS-CoV-2 begins prior to the

development of symptoms and is highest early in the

course of illness. Detectable viral RNA, however,

does not necessarily indicate the presence of

infectious virus, and there appears to be a threshold

of viral RNA level below which infectiousness is

unlikely.

(4)

Risk of transmission depends on exposure type:

The risk of transmission after contact with an

individual with COVID-19 increases with the

closeness and duration of contact and appears

highest with prolonged contact in indoor settings.

Thus, most secondary infections have been described

in the following settings:

●Among household contacts

●In health care settings when personal protective

equipment was not used

●In other congregate settings where individuals are

residing or working in close quarters

(5)

Asymptomatic or presymptomatic

transmission :

The levels and duration of viral RNA in the upper

respiratory tract of asymptomatic patients are also

similar to those of symptomatic patients.

The risk of transmission from an individual who is

asymptomatic appears less than that from one who is

symptomatic.

A CDC modeling study estimated that 59 percent of

transmission could be attributed to individuals without

symptoms: 35 percent from presymptomatic

individuals, and 24 percent from those who remained

asymptomatic.

(6)

Enviromental contamination:

contaminated surfaces are not thought to be a major

source of transmission. It may be more likely a

potential source of infection in settings where there is

heavy viral contamination (eg, in an infected

individual's household or in health care settings).

various disinfectants (including ethanol at

concentrations between 62 and 71%) inactivated a

number of coronaviruses related to SARS-CoV-2

within one minute . Simulated sunlight has also been

shown to inactivate SARS-CoV-2 over the course of

15 to 20 minutes in experimental conditions, with

higher levels of ultraviolet-B (UVB) light associated

with more rapid inactivation.

(7)

Given the uncertainty regarding the transmission risk

and the apparent susceptibility of some animals to

SARS-CoV-2 infection, the United States CDC

recommends that pets be kept away from other

animals or people outside of the household and that

people with confirmed or suspected COVID-19 try to

avoid close contact with household pets, as they

should with human household members, for the

duration of their self-isolation period.

There have been no reports of domesticated animals

(other than mink) transmitting SARS-CoV-2 infection

to humans.

(8)

Risk factors for severe illness

• Increasing age:older adults are more likely to have severe disease.Older age is also associated with increased mortality.

Symptomatic infection in children and adolescents appears to be relatively uncommon; when it occurs, it is usually mild.

• Comorbidities:

●Cardiovascular disease

●Diabetes mellitus

●Chronic obstructive pulmonary disease and other lung diseases

●Cancer (in particular hematologic malignancies, lung cancer, and metastatic disease)

●Chronic kidney disease

●Solid organ or hematopoietic stem cell transplantation

●Obesity

●Smoking

(9)

Socioeconomic background and sex:

Males have comprised a disproportionately high

number of critical cases and deaths in multiple

cohorts worldwide

Black, Hispanic, and South Asian individuals comprise

a disproportionately high number of infections and

deaths due to COVID-19 in the United States and

United Kingdom, likely related to underlying

disparities in the social determinants of health

(10)

Laboratory abnormalities

•Lymphopenia

•Thrombocytopenia

•Elevated liver enzymes

•Elevated lactate dehydrogenase (LDH)

•Elevated inflammatory markers (eg, C-reactive protein

[CRP], ferritin) and inflammatory cytokines (ie, interleukin 6 [IL-6] and tumor necrosis factor [TNF]-alpha)

•Elevated D-dimer (>1 mcg/mL)

•Elevated prothrombin time (PT)

•Elevated troponin

•Elevated creatine phosphokinase (CPK)

• •Acute kidney injury

(11)

Deficiencies in certain micronutrients, in

particular vitamin D , have been associated

with more severe disease in observational

studies, but multiple confounders likely impact

the observed associations. There is also no

high-quality evidence that reversing

micronutrient deficiencies with

supplementation improves COVID-19

outcomes.

(12)

Viral factors

Patients with severe disease have also been

reported to have higher viral RNA levels in

respiratory specimens than those with milder

disease , although some studies have found

no association between respiratory viral RNA

levels and disease severity . Detection of viral

RNA in the blood has been associated with

severe disease, including organ damage (eg,

lung, heart, kidney), coagulopathy, and

mortality

(13)

Genetic factors

Host genetic factors are also being evaluated

for associations with severe disease .

As an example, one genome-wide association

study identified a relationship between

polymorphisms in the genes encoding the

ABO blood group and respiratory failure from

COVID-19 (type A associated with a higher

risk) . Type O has been associated with a

lower risk of both infection and severe

disease

^.

(14)

(15)

(16)

Clinical feaures

Incubation period (14 days) 4_5 days after

exposure

ASYMPTOMATIC INFECTIONS

One review estimated that 33 percent of people

with SARS-CoV-2 infection never develop

symptoms

Patients with asymptomatic infection may have objective clinical abnormalities . As an example, in a study of 24 patients with asymptomatic infection who all underwent chest computed tomography (CT), 50 percent had typical ground-glass opacities or patchy shadowing, and another 20 percent had atypical imaging abnormalities . Five

patients developed low-grade fever, with or without other typical symptoms, a few days after diagnosis

(17)

370,000 confirmed COVID-19:

●Cough in 50 percent

●Fever (subjective or >100.4°F/38°C) in 43 percent

●Myalgia in 36 percent

●Headache in 34 percent

●Dyspnea in 29 percent

●Sore throat in 20 percent

●Diarrhea in 19 percent

●Nausea/vomiting in 12 percent

●Loss of smell or taste, abdominal pain, and rhinorrhea in fewer than 10 percent each

(18)

(19)

Acute course and complications

●Respiratory failure

●Cardiac and cardiovascular complications

●Thromboembolic complications

●Neurologic complications

●Inflammatory complications

●Secondary infections

(20)

treatment

• Colchicine:the benefit is modest without a reduction in mortality, and adverse effects are common

• Ivermectin :there is a lack of high-quality data to support its efficacy

• Hydroxychloroquine and azithromycin

• there are no high-quality data that supplementation with vitamin C, vitamin D, or zinc reduces the severity of

COVID-19 in non-hospitalized patients

• Interferons:clinical data do not indicate a clear benefit of interferon beta for severe COVID-19

(21)

Favipiravir : Favipiravir is an RNA polymerase

inhibitor available in some Asian countries for

treatment of influenza and available in India for

treatment of mild COVID-19. Another trial in Iran

suggested no benefit with favipiravir for severe

COVID-19

Remdesivir: Remdesivir is a novel

nucleotide analog that has in vitro activity against

severe acute respiratory syndrome coronavirus 2

(SARS-CoV-2) . If available, we suggest

remdesivir for hospitalized patients with severe

COVID-19

(22)

Dexamethasone and other

glucocorticoids

We recommend dexamethasone for

severely ill patients with COVID-19 who

are on supplemental oxygen or

ventilatory support

(23)

Recovery and long-term

sequelae

The time to recovery from COVID-19 is highly variable and depends on age and pre-existing comorbidities in addition to illness severity.

Individuals with mild infection are expected to recover relatively quickly (eg, within two weeks) whereas many individuals with severe disease have a longer time to recovery (eg, two to three months). The most common

persistent symptoms include fatigue, dyspnea, chest pain, cough, and cognitive deficits

(24)

(25)

(26)

ﻦﯾﺮﺘﻬﺑ ﺖﺳا ماﺪﮐ ﻦﺴﮐاو

؟

ﺖﺳا ﯽﻨﺴﮐاو ﻦﯿﻟوا ،ﻦﺴﮐاو ﻦﯾﺮﺘﻬﺑ ﻪﮐ

سﺮﺘﺳد رد ﺎﻣ

ﯽﻣراﺮﻗ دﺮﯿﮔ

ﺪﯾوﻮﮐ ﻪﺑﻼﺘﺑا ﻪﻘﺑﺎﺳ -

91 دراد ﻦﺴﮐاو ﻖﯾرﺰﺗ ﺮﺑ يﺮﯿﺛﺎﺗ ﻪﭼ

؟

ﯽﺗرﻮﺻرد ﺖﺤﺗ رﺎﻤﯿﺑ ﻪﮐ

يرﺎﻤﯿﺑ ﻢﺋﻼﻋ و ﺪﺷﺎﺒﻧ راد ﺐﺗ ،ﺪﺷﺎﺑ ﻪﺘﻓﺮﮕﻧ راﺮﻗ ﯽﭘاﺮﺗﺎﻤﺳﻼﭘ

يﺎﻫرﺎﯿﻌﻣ و ﺪﺷﺎﺑ ﻪﺘﻓﺎﯾ دﻮﺒﻬﺑ مزﻻ

جوﺮﺧ ياﺮﺑ زا

ار ﻪﻨﯿﻄﻧﺮﻗ ﻊﻧﺎﻣﻼﺑ ﻦﺴﮐاو ﻖﯾرﺰﺗ ﻪﺘﺷاد

ﺖﺳا .

رد ﯽﻧارﺎﻤﯿﺑ ﻪﮐ

ﯽﭘاﺮﺗﺎﻤﺳﻼﭘ ﺎﯾ

لﺎﻧﻮﻠﮐﻮﻧﻮﻣ ﯽﺘﻧآ

يدﺎﺑ

ﺖﻓﺎﯾرد هدﺮﮐ

ﺪﻧا ﺮﺘﻬﺑ

ﺖﺳا . دﻮﺷ مﺎﺠﻧا ﺎﻫ نﺎﻣرد ﻦﯾا ﺖﻓﺎﯾرد زا ﺪﻌﺑ هﺎﻣ 3ﻞﻗاﺪﺣ نﻮﯿﺳﺎﻨﯿﺴﮐاو يزﺎﺳاﺪﺟ ﻪﺑ زﺎﯿﻧ ﻖﯾرﺰﺗ زا ﺪﻌﺑ و دراد دﻮﺟو ﻦﺴﮐاو ﻖﯾرﺰﺗ ﺮﺛا رد ﺎﻧوﺮﮐ ﻪﺑ ﻼﺘﺑا نﺎﮑﻣا ﺎﯾ

ﻢﯾراد

؟

ﺮﯿﺧ ! سوﺮﯾو يوﺎﺣ ﺎﯾ ﻪﺘﺷاﺪﻧ ﯽﺳوﺮﯾو ﺎﯾ ﺎﻫ ﻦﺴﮐاو ﯽﻣﺎﻤﺗ ﺎﯾ هﺪﺷ ﻪﺘﺸﮐ

هﺪﺷ لﺎﻌﻓﺮﯿﻏ هدﻮﺑ

ﺖﯿﻠﺑﺎﻗ ﻪﮐ ﻪﻨﯿﻄﻧﺮﻗ و يزﺎﺳاﺪﺟ ﻪﺑ يزﺎﯿﻧ ﻦﺴﮐاو ﻖﯾرﺰﺗ زا ﺪﻌﺑ وﺪﻧراﺪﻧ ار يرﺎﻤﯿﺑ لﺎﻘﺘﻧا

دراﺪﻧ دﻮﺟو .

(27)

يرﺎﻤﯿﺑ ﻪﺑﻼﺘﺒﻣ دﺮﻓ ﺎﺑ ﻪﻬﺟاﻮﻣ ﻪﻘﺑﺎﺳ ﻪﭼ ﺪﯾوﻮﮐ

دراد ﻦﺴﮐاو ﻖﯾرﺰﺗ ﺮﺑ يﺮﯿﺛﺂﺗ

؟

ﺖﺴﺗ ﺪﯾﺎﺑ اﺪﺘﺑا دﻮﺷ مﺎﺠﻧاPCR

. ﺖﺴﺗ ندﻮﺑ ﺖﺒﺜﻣ ترﻮﺻ رد ﻖﯾرﺰﺗ ﻦﺴﮐاو ﺪﯾﺎﺒﻧPCR

دﻮﺷ . ﺖﺴﺗ ﻪﮐ ﯽﺗرﻮﺻ رد ياﺮﺑ رﺎﻤﯿﺑ ﺪﺷﺎﺑ ﯽﻔﻨﻣPCR

تﺪﻣ 7

- 14 ﺪﯾﺎﺑ زور زوﺮﺑ ﺮﻈﻧ زا

ﻢﺋﻼﻋ ﺶﯾﺎﭘ ﺪﯾوﻮﮐ

دﻮﺷ . ﻪﮐ يدراﻮﻣ رد ﺪﻌﺑ ﻢﺋﻼﻋ

نﻮﯿﺳﺎﻨﯿﺴﮐاو ،ﺪﻨﮑﻧ زوﺮﺑ تﺪﻣ ﻦﯾا زا

مﺎﺠﻧا ﺪﻧاﻮﺗ ﯽﻣ دﻮﺷ

.

ا ﻢﺋﻼﻋ ﻦﺘﺷاد ﺎﯾ يﺎﻫ يرﺎﻤﯿﺑ

ﻞﺒﻗ ﯽﻧﻮﻔﻋ ﺖﺳا ﻦﺴﮐاو ﺢﯿﻘﻠﺗ ياﺮﺑ ﯽﻌﻧﺎﻣ ،ﻦﺴﮐاو ﺖﻓﺎﯾرد

؟

رد ﯽﺗرﻮﺻ ﻪﮐ

دﺮﻓ ﺖﻓﺎﯾرد هﺪﻨﻨﮐ

ﻦﺴﮐاو رد

زور نﻮﯿﺳﺎﻨﯿﺴﮐاو رﺎﭼد

ﻢﺋﻼﻋ يرﺎﻤﯿﺑ

يﺎﻫ

ﯽﻧﻮﻔﻋ )

،ﺐﺗ

،زﺮﻟ

،يﮋﻟﺎﯿﻣ

،يﮋﻟاﺮﺗرآ

،ﯽﺗﺎﭘﻮﻧدﺎﻔﻨﻟ

،عﻮﻬﺗ ﯽﺑ

،ﯽﯾﺎﻬﺘﺷا

،ﻪﻓﺮﺳ ﯽﮕﻨﺗ

،ﺲﻔﻧ

،ﻂﻠﺧ درد

،ﻢﮑﺷ

،لﺎﻬﺳا ﺲﯾد

،يروا درد

ﮏﯿﺑﻮﭘاﺮﭘﻮﺳ و

...

( ﺪﺷﺎﺑ ﺮﺘﻬﺑ

ﺖﺳا ﻖﯾرﺰﺗ

ﻦﺴﮐاو

ﺎﺗ ﯽﻧﺎﻣز ﻪﮐ

ﺐﺗ رﺎﻤﯿﺑ ﻊﻓر

دﻮﺷ و ﻢﺋﻼﻋ ﻪﺑ

رﻮﻃ ﻞﻣﺎﮐ دﻮﺒﻬﺑ

اﺪﯿﭘ ﺪﻨﮐ ﻪﺑ ﻖﯾﻮﻌﺗ ﺪﺘﻓﻮﯿﺑ

.

(28)

ﯽﻣ لﺮﺘﻨﮐ ياﺮﺑ ﯽﯾوراد ،ﻦﺴﮐاو ﻖﯾرﺰﺗ زا ﻞﺒﻗ ناﻮﺗ ﯽﻟﺎﻤﺘﺣا ضراﻮﻋ

دﻮﻤﻧ فﺮﺼﻣ

؟

ﻖﯾرﺰﺗ زا ﻞﺒﻗ ﺖﻬﺟ ﻦﺴﮐاو

ﺪﺿ يﺎﻫوراد ،ﻦﻓﻮﻨﯿﻣﺎﺘﺳا زا هدﺎﻔﺘﺳا ضراﻮﻋ زوﺮﺑ زا يﺮﯿﮕﺸﯿﭘ

دﻮﺷ ﯽﻤﻧ ﻪﯿﺻﻮﺗ ﺎﻫ ﻦﯿﻣﺎﺘﺴﯿﻫ ﯽﺘﻧآ و يﺪﯿﺋوﺮﺘﺳا ﺮﯿﻏ بﺎﻬﺘﻟا .

ﺚﻋﺎﺑ ﺖﺳا ﻦﮑﻤﻣ ﻦﻓﻮﻨﯿﻣﺎﺘﺳا

دﻮﺷ ﻦﺴﮐاو ﯽﯾاز ﯽﻨﻤﯾا ﻞﯿﺴﻧﺎﺘﭘ ﺶﻫﺎﮐ .

ﺚﻋﺎﺑ ﺪﻧاﻮﺗ ﯽﻣ ﺎﻫ ﻦﯿﻣﺎﺘﺴﯿﻫ ﯽﺘﻧآ زا هدﺎﻔﺘﺳا

دﻮﺷ ﻦﺴﮐاو ﻖﯾرﺰﺗ زا ﺪﻌﺑ ﯽﺴﮐﻼﯿﻓﺎﻧآ ﻢﺋﻼﻋ نﺪﺷ هﺪﻧﺎﺷﻮﭘ .

يﺎﻫوراد ،ﻦﻓﻮﻨﯿﻣﺎﺘﺳا زا هدﺎﻔﺘﺳا

ﻦﺴﮐاو ﻖﯾرﺰﺗ زا ﺪﻌﺑ ،ضراﻮﻋ لﺮﺘﻨﮐ ياﺮﺑ ﺎﻫ ﻦﯿﻣﺎﺘﺴﯿﻫ ﯽﺘﻧآ و يﺪﯿﺋوﺮﺘﺳا ﺮﯿﻏ بﺎﻬﺘﻟا ﺪﺿ دراﺪﻧ ﯽﺘﻌﻧﺎﻤﻣ .

زا هدﺎﻔﺘﺳا ،ﺎﮑﻧزاﺮﺘﺳآ ﻦﺴﮐاو ردﺎﻧ رﺎﯿﺴﺑ ضراﻮﻋ زوﺮﺑ زا يﺮﯿﮕﺸﯿﭘ ياﺮﺑ

ﺪﻨﻧﺎﻣ ﻢﯿﻘﺘﺴﻣ ﯽﮐارﻮﺧ يﺎﻫ ﺖﻧﻻﻮﮔاﻮﮐ ﯽﺘﻧآ ،ﻦﯾرﺎﻓراو ،ﻦﯾرﺎﭙﺘﻟاد ،ﻦﯾرﺎﭘﺎﺴﮐﻮﻧا ،ﻦﯾرﺎﭙﻫ ﻪﯿﺻﻮﺗ ﺖﮐﻼﭘ ﺪﺿ يﺎﻫوراد ﺮﯾﺎﺳ ﺎﯾ و ﻦﯾﺮﭙﺳآ ،ناﺮﺗﺎﮕﯿﺑاد و نﺎﺑﺎﺴﮐوراﻮﯾر دﻮﺷ ﯽﻤﻧ .

(29)

يرادرﺎﺑ

ندﻮﺑ دوﺪﺤﻣ ﻞﯿﻟد ﻪﺑ ﮏﯿﻨﺗﻮﭙﺳا و ﻦﯿﺴﮐوﻮﮐ ،مرﺎﻓﻮﻨﯿﺳ يﺎﻫ ﻦﺴﮐاو رد تﺎﻋﻼﻃا

يرادرﺎﺑ

فﺮﺼﻣ ﻊﻨﻣ ﺪﻧراد

.

يرﺎﻤﯿﺑ ﻪﺑﻼﺘﺑا ياﺮﺑﻻﺎﺑ ﮏﺴﯾر رد رادرﺎﺑ ﻢﻧﺎﺧ ﻪﮐ ﯽﺗرﻮﺻ رد راﺮﻗ ﺪﯾوﻮﮐ

ﺎﯾ و ﺪﺷﺎﺑ ﻪﺘﺷاد

ﺪﯾﺪﺸﺗ ياﺮﺑ رﻮﺘﮐﺎﻓ ﮏﺴﯾر دﻮﺟو ﺪﯾوﻮﮐ يرﺎﻤﯿﺑ

ﺎﺑ ﺪﺷﺎﺑ ﻪﺘﺷاد ﺪﯾﺪﺣﻼﺻ

ﺞﻟﺎﻌﻣ ﮏﺷﺰﭘ

ﺪﯾﺎﻤﻧ ﻖﯾرﺰﺗ ار ﺎﮑﻧزاﺮﺘﺳآ ﻦﺴﮐاو ﺪﻧاﻮﺗ ﯽﻣ .

يرادرﺎﺑ ﺪﺼﻗ هﺪﺷ ﻪﻨﯿﺴﮐاو دﺮﻓ ﻪﮐ ﯽﺗرﻮﺻ رد

دراﺪﻧ دﻮﺟو يرادرﺎﺑ ﻪﺑ ماﺪﻗا رد ﺮﯿﺧﺎﺗ ﻪﺑ يزﺎﯿﻧ ﺪﺷﺎﺑ ﻪﺘﺷاد .

(30)

ﯽﻫدﺮﯿﺷ

يﺎﻫ ﻦﺴﮐاو ﻪﮐ ﯽﯾﺎﺟ نآ زا ﺮﯿﻏ ﺪﯾوﻮﮐ

يﺮﻄﺧ ﺪﺳر ﯽﻤﻧ ﺮﻈﻧ ﻪﺑ ﺪﻨﺘﺴﻫ هﺪﻧز ﺮﯿﻏ و لﺎﻌﻓ

ﺪﺷﺎﺑ ﻪﺘﺷاد دازﻮﻧ ياﺮﺑ .

ندﻮﺑ دوﺪﺤﻣ ﻞﯿﻟد ﻪﺑ ﮏﯿﻨﺗﻮﭙﺳا و ﻦﯿﺴﮐوﻮﮐ ،مرﺎﻓﻮﻨﯿﺳ يﺎﻫ ﻦﺴﮐاو

تﺎﻋﻼﻃا رد

فﺮﺼﻣ ﻊﻨﻣ ﯽﻫدﺮﯿﺷ ﺪﻧراد

.

ﯽﺗرﻮﺻرد يرﺎﻤﯿﺑ ﻪﺑﻼﺘﺑا ياﺮﺑ ﻻﺎﺑ ﮏﺴﯾر رد هدﺮﯿﺷ ﻢﻧﺎﺧ ﻪﮐ

راﺮﻗ ﺪﯾوﻮﮐ ﺎﯾ و ﺪﺷﺎﺑ ﻪﺘﺷاد

ﺪﯾﺪﺸﺗ ياﺮﺑ رﻮﺘﮐﺎﻓ ﮏﺴﯾر دﻮﺟو يرﺎﻤﯿﺑ

ﺎﺑ ﺪﺷﺎﺑ ﻪﺘﺷاد ﺪﯾﺪﺣﻼﺻ

ﺪﻧاﻮﺗ ﯽﻣ ﺞﻟﺎﻌﻣ ﮏﺷﺰﭘ

ﺪﯾﺎﻤﻧ ﻖﯾرﺰﺗ ار ﺎﮑﻧزاﺮﺘﺳآ ﻦﺴﮐاو .

ﻊﻄﻗ ﯽﻫدﺮﯿﺷ ﺖﺴﯿﻧ زﺎﯿﻧ ﺎﮑﻧزاﺮﺘﺳآ ﻦﺴﮐاو ﻖﯾرﺰﺗ زا ﺪﻌﺑ

دﻮﺷ .

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